[Separate entrance of the main pancreatic duct and of the common bile duct: is it synonymous with easy retrograde cholangiography using endoscopic approach?] / Abouchement séparé du canal pancréatique principale et du cholédoque: est- il synonyme de cholangiographie rétrograde par voie endoscopique facile?

This study focused on endoscopic examination of a prominent papilla which showed two separate orifices revealing separate entrance of the main pancreatic duct and of the common bile duct (A). This was the most rare anatomoendoscopic variation, accounting for only 10% of retrograde cholangiopancreatographies using endoscopic approach (ERCP). However, it facilitated selective biliary catheterization (SBC) in our patient, as one might have expected. Papilla had a pseudo polypoid appearance and a biliary orifice (BO) at the right angle toward the duodenal wall; hence this was a more difficult approach than that via the pancreatic orifice (PO) which, on the other hand, required undesired pancreatic catheterization (B). As SBC was the approach we decided to adopt, the special techniques to consider in this particular case were: transpancreatic sphincterotomy (TPS) alone or TPS after implantation of a pancreatic stent (PS). We opted for the second technique (STP + PS) and we noticed that the implantation of a PS resulted in better BO visualization (C). We could perform SBC without recourse to TPS. In this specific case, as in other cases of difficult SBC in our practice, PS has proven effectiveness.

Impacted and Fractured Biliary Basket: A Second Basket Rescue Technique.

A 59-year-old woman was treated with ERCP, ES, and biliary plastic stent, for large and multiple common bile duct stones. During a second ERCP basket extraction was impacted with a round entrapped stone. The basket handle was cut off; a metal sheath of extraendoscopic lithotriptor was advanced over the basket. The mechanical lithotripsy was complicated with basket traction wires fracturing, without breakage of the stone. A rescue standard basket was pushed until it caught the basket/stone complex. Using this method disengagement of the whole fractured basket/stone complex was achieved without need of surgery. It is the third case reported in the English literature.

Endoscopic retrieval of gastric trichobezoar after fragmentation with electrocautery using polypectomy snare and argon plasma coagulation in a pediatric patient.

Trichobezoars are rare, composed of hair and more common in female pediatric patients with psychiatric disorders. Open surgical extraction is the most common removal method. Only two endoscopic removals after fragmentation have been reported in the English literature. We report herein a third case of a trichobezoar that was successfully retrieved after endoscopic fragmentation with snare polypectomy and argon plasma coagulation in a six-year-old female patient. The trichobezoar mass was completely removed in 10 pieces after 15 passes. The patient's course was uneventful. Nine months later, she is doing well. This endoscopic removal was effective, minimally invasive and time saving.

Endoscopic stenting and clipping for anastomotic stricture and persistent tracheoesophageal fistula after surgical repair of esophageal atresia in an infant.

Anastomotic stricture (AS) and recurrent tracheoesophageal fistula (TEF) are two complications of surgical repair of esophageal atresia (EA). Therapeutic endoscopic modalities include stenting, tissue glue, and clipping for TEF and endoscopic balloon dilation bougienage and stenting for esophageal strictures. We report herein a two-month infant with both EA and TEF who benefited from a surgical repair for EA, at the third day of life. Two months later he experienced deglutition disorders and recurrent chest infections. The esophagogram showed an AS and a TEF confirmed with blue methylene test at bronchoscopy. A partially covered self-expanding metal type biliary was endoscopically placed. Ten weeks later the stent was removed. This allows for easy passage of the endoscope in the gastric cavity but a persistent recurrent fistula was noted. Instillation of contrast demonstrated a fully dilated stricture but with a persistent TEF. Then we proceeded to placement of several endoclips at the fistula site. The esophagogram confirmed the TEF was obliterated. At 12 months of follow-up, he was asymptomatic. Stenting was effective to alleviate the stricture but failed to treat the TEF. At our knowledge this is the second case of successful use of endoclips placement to obliterate recurrent TEF after surgical repair of EA in children.

Incidental diagnostic and treatment of a suppurative appendicitis at colonoscopy.

WE HEREIN REPORT A PATIENT WITH ACUTE APPENDICITIS WHO WAS DIAGNOSED BY COLONOSCOPY: a 54-year-old woman with normal physical examination and laboratory results within normal limits. The case had shown an erythematous and edematous bulging polypoid lesion with purulent discharging from appendiceal orifice into the cecum. At colonoscopy, appendix appeared as an erythematous and edematous bulging polypoid lesion with purulent discharging from appendiceal orifice into the coecum. Surgeons exclude any emergency. Two weeks later, a colonoscopic second look was performed, and the same bulging polypoid lesion was found but without spontaneous purulent discharging. Appendiceal endoscopic pus drainage was then performed.